肾气厥逆,腹痛下利,手足厥冷,小便清利,茴香四逆汤主之。
茴香四逆汤(自制)
小茴香(二钱) 附子(三钱) 干姜(一钱) 破故纸(二钱) 杜仲(五钱)
茯苓(二钱) 甘草(五分) 大枣(三枚) 水三钟,煎一钟,温服。
四逆汤本治少阴,此方加茴香泄肾邪,佐以茯苓;再加杜仲、故纸补命门,兼治泄泻;红枣能补土,与茯
苓同用,又能泄肾中水气。仲圣治奔豚,有苓桂枣甘汤,此方去桂代以茴香,更见立方之妙。祖怡注。
肝气厥逆,胁下及腹中绞痛,下利,手足厥冷,指爪皆青,茱萸附桂汤主之。
茱萸附桂汤(自制)
吴萸(七分) 附子(二钱) 肉桂(八分) 当归(三钱) 白芍(一钱五分)
白术(一钱) 木香(六分) 乌药(一钱) 枣(二枚) 姜(三片)
此方于四逆汤只取附子一味,以去沉寒,而以茱萸附桂名者,先生注重在厥阴也。厥阴为藏血之脏,
当然以和营为主。方意取材于当归四逆,加吴萸、生姜,去细辛、甘草、木通,以肉桂易桂枝,附、桂同用,加
入吴萸,直驱厥阴之寒;以归、芍和血,木香、乌药顺气止痛,而用白术、姜、枣,补脾正所以和营也。祖怡注。
以上四方,虽治中寒,仍顾脾胃,先生常云,脾阳不运,虚则寒生。且脾主四肢,四逆之症,固以温本脏为
主,而总不离乎脾,实理所当然矣。祖怡又注。
When Kidney Qi rebels and reverses, presenting with abdominal pain, diarrhea, cold limbs, and clear, profuse urination, Huixiang Sini Tang (Fennel Decoction for Reversal of Cold) should be used as the primary treatment.
Huixiang Sini Tang (Self-made Formula)
Aniseed Fructus (Xiaohuixiang, 2 qian) Aconiti Lateralis Radix Preparata (Fuzi, 3 qian) Zingiberis Rhizoma (Ganjiang, 1 qian) Cistanches Herba (Poguzhi, 2 qian) Eucommiae Cortex (Duzhong, 5 qian)
Poria (Fuling, 2 qian) Glycyrrhizae Radix et Rhizoma (Gancao, 0.5 qian) Jujubae Fructus (Dazao, 3 pieces)
Boil in three bowls of water until one bowl remains; take warm.
Sini Tang (Decoction for Reversal of Cold) is originally indicated for Shaoyin disease (disease of the Shaoyin channel). This formula adds Aniseed to drain pathogenic factors from the Kidney, assisted by Poria; it further adds Eucommia and Cistanche to tonify the Mingmen (Gate of Life), simultaneously treating diarrhea; Jujube can tonify the Spleen Earth, and when used together with Poria, it can also drain damp-water qi from the Kidney. Zhang Zhongjing treated Ben Tun (a condition characterized by a sensation of gas rushing upward from the lower abdomen) with Linggui Zaogan Tang (Poria, Cinnamon Twig, Jujube, and Licorice Decoction); this formula removes Cinnamon Twig and substitutes it with Aniseed, demonstrating the ingenuity of its formulation. Note by Zuyi.
When Liver Qi rebels and reverses, presenting with severe cramping pain in the hypochondrium and abdomen, diarrhea, cold limbs, and cyanosis of the fingernails, Zhuyu Fugui Tang (Cornus, Aconite, and Cinnamon Bark Decoction) should be used as the primary treatment.
Zhuyu Fugui Tang (Self-made Formula)
Evodiae Fructus (Wuyu, 0.7 fen) Aconiti Lateralis Radix Preparata (Fuzi, 2 qian) Cinnamomi Cortex (Rougui, 0.8 fen) Angelicae Sinensis Radix (Danggui, 3 qian) Paeoniae Radix Alba (Baishao, 1.5 qian)
Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian) Aucklandiae Radix (Muxiang, 0.6 fen) Linderae Radix (Wuyao, 1 qian) Jujubae Fructus (Zao, 2 pieces) Zingiberis Rhizoma Recens (Jiang, 3 slices)
This formula uses only Aconite from Sini Tang to eliminate deep-seated cold. It is named Zhuyu Fugui Tang because the author emphasizes the involvement of Jueyin disease (disease of the Jueyin channel). Jueyin is the zang organ that stores blood, so the primary approach must be to harmonize Ying (Nutritive Qi). The conceptual basis of the formula derives from Danggui Sini Tang (Angelica Decoction for Reversal of Cold), adding Evodia and Fresh Ginger, removing Cimicifugae Rhizoma, Licorice, and Akebia Caulis, substituting Cinnamon Twig with Cinnamon Bark. The combined use of Aconite and Cinnamon Bark, along with Evodia, directly drives out cold from the Jueyin channel; Angelica and White Peony Root harmonize the blood; Aucklandia and Lindera regulate Qi and relieve pain; while Atractylodes, Ginger, and Jujube tonify the Spleen, which serves to harmonize Ying Qi. Note by Zuyi.
Although these four formulas are used to treat Middle Cold syndrome (cold pathogens striking the interior organs directly), they still attend to the Spleen and Stomach. The author often stated: "When Spleen Yang fails to transform, deficiency leads to the generation of cold." Furthermore, the Spleen governs the four limbs. Although the symptom of Si Ni (cold extremities) primarily requires warming the affected zang organ, it invariably involves the Spleen, which is indeed logical. Note by Zuyi again.